4:42 PM PDT, June 30, 2012
Manchester in Clay County is about 80 miles and 90 minutes from Danville. It would seem an unusual stretch of highway to travel to see a psychiatrist.
Yet, Clay County Sheriff Kevin Johnson said “carloads” of residents there made that trip regularly to see Dr. Melborne Williams. They did not come to seek counseling from Williams, Johnson speculated, they came to get prescriptions for Xanax and other controlled drugs.
In the past year, 12 Clay County residents who were Williams’ patients were found dead of accidental drug overdoses, leading the state Board of Medical Licensure to issue an emergency suspension of Williams’ medical license last week.
Johnson’s criminal investigation into the “direct link” between the overdoses and the drugs prescribed by Williams is ongoing, and other law enforcement agencies also are looking into the deaths, he said.
“His name popped up everywhere,” the sheriff said. “Here would be a dead body and two feet away would be a pill bottle with Dr. Williams’ name on it.”
When Williams’ name appeared Friday in The Advocate-Messenger in a story about the emergency suspension of his medical license, it caught the attention of Lincoln County Coroner Farris Marcum.
Marcum recalled being called to the scene of a fatal crash on U.S. 150 near Crab Orchard on April 13. James Layton, 51, of Clay County, was killed when his pickup truck went off the road and flipped over about 10 a.m. Layton was not under the influence of alcohol or drugs when he crashed, Marcum said, but his brother and nephew, who were traveling with Layton in a separate vehicle, said they were going to Danville for an appointment with Williams.
“I thought it was strange, him coming from Clay County to see a doctor, but it is what it is,” Marcum said.
The allegations against Williams — who was on staff at Ephraim McDowell Region Medical Center for 13 years without incident until his suspension by the medical board — have prompted Marcum to begin reviewing “several” drug overdoses that have occurred in Lincoln County in the last year and a half.
One of those overdoses — Crystal Hager, 32, of Hustonville, who died in January with multiple drugs and alcohol in her system — was a patient of Williams, her mother, Serenna Sizemore, said Friday. Crystal Hager was the ex-wife of Thomas Wayne Hager Jr., who is accused of shooting two men to death and seriously wounding another in Danville in May in what police say was a drug-related incident.
“As a coroner, doing your due diligence, I think you need to go back and look to see if there are any red flags,” Marcum said.
The news of the psychiatrist’s suspension also caught the attention of Boyle County Coroner Dr. Don Hamner, who has known Williams for several years.
“I was actually shocked when I heard it,’ Hamner said Friday.
Hamner said he has only investigated a handful of accidental drug overdoses in his nearly two years on the job. Checking to see where the lethal drugs came from is included in a death investigation in such cases, Hamner said, but Williams’ name has never come up in any of his investigations.
“I’ve seen nothing at all related to him,” the Boyle coroner said.
Williams has been unavailable for comment, but one of his attorneys, James E. Smith of Louisville, told the Lexington Herald-Leader that Williams plans to vigorously defend himself against the charges leveled in the medical board’s suspension order. The 12 Clay County overdose victims also had in their systems narcotics prescribed by other doctors, and some also were using street drugs, Smith said.
“We are confident that once the allegations are fully analyzed that Dr. Williams will be fully vindicated,” Smith told the Lexington paper. “We are certain that his prescribing practices did not lead to the death of those 12 patients.”
Williams is scheduled for a formal, trial-like hearing before the medical licensure board in December, said Leeann Diakov, the board’s assistant general counsel. Williams could permanently lose his medical license, it could be restricted or he could be cleared at the hearing, Diakov said.
Williams also has the option of challenging his suspension to have it reduced or lifted before the hearing, Diakov said. One of his attorneys indicated such a challenge is planned after Williams undergoes a neuropsychological evaluation as ordered as part of his suspension, she said.
According to the medical board’s complaint, Williams’ practice came to its attention in October, when one of the agency’s investigators reported several confidental informants used by police in drug cases identified Williams as a “reliable source” for Xanax, a commonly abused anti-anxiety medication often referred to as nerve pills.
A¿nurse at the Manchester hospital called the medical board in December to report a trend of overdoses with Xanax and other drugs prescribed by Williams. In January, Johnson and Clay County Coroner Danny Finley called the board with similar concerns, according the suspension order.
A medical board investigator interviewed Dr. Bryan Wood and Dr. Stuart Larson of the Centex clinic in Danville, where Williams practiced for about a month in 2011 before being dismissed. Williams brought many of his patients from his private practice with him when he joined Centex, said Wood, who owns the clinic.
Larson, also a psychiatrist, said he became concerned when he noticed several cars with license plates from across Kentucky in the clinic’s parking lot and heard other patients complaining about “junkies” hanging around the clinic, the order states.
Wood said he reviewed Williams’ records and discovered that 97 percent of his patients were being prescribed high doses of Xanax and a cocktail of other drugs including Seroquel, Klonopin and Trazodone. Another review of the clinic’s records showed Williams saw an average of 41 patients a day at Centex, more that twice as many as Larson. The average visit between Williams and a patient lasted five to seven minutes, the suspension order states.
Woods, who works in the emergency room at Fort Logan Hospital and also is part owner of 11 SelfRefind addiction treatment clinics in Kentucky, including one in Danville, said in an interview Friday it didn’t take he and Larson long to conclude something was out of line with Williams’ practice at Centex.
“The problem raised its head very quickly, and we dealt with it with expediency,” Wood said.
The high rate of patients being prescribed high levels of Xanax and other drugs, the short time spent with patients and “people coming long distances — that just didn’t feel right,” Wood said.
Noting he is not a psychiatrist, Wood said the drug cocktail most often prescribed by Williams is potentially dangerous, especially if used in combination with other drugs. A mixture of Xanax, Seroquel (anti-psychotic), Klonopin (anti-anxiety) and Trazodone (anti-depressant commonly prescribed as a sleep aid) is a potent combination, he said.
“When you prescribe all this together ... wow, that’s really going to slow you down,” he said.
Wood said Williams, whom he had known and respected for several years, was recruited to Centex to see SelfRefind patients, mostly pain pill addicts, who needed psychiatric help along with other forms of treatment. Centex will close later this month, and SelfRefind patients will receive psychiatric treatment in the SelfRefind clinics, Wood said.
Wood himself is currently under an agreed order with the licensure board — entered last month — that restricts him from prescribing Suboxone, a controversial drug used to treat people addicted to painkillers. Wood has defended his use of Suboxone to treat addicts for years while the medical board alleges that Wood overprescribes the drug.
After leaving Centex, Williams opened a practice on Daniel Drive and later moved his office to Martin Luther King Boulevard. He previously had a private practice in Green Leaf Shopping Center. He also admitted and treated patients at the behavioral health unit at Ephraim McDowell for 13 years, and has been in practice for a total of 40 years.
As part of its investigation, the medical board hired Dr. George R. Schrodt to review Williams’ records. Schrodt, an associate professor of psychiatry and behavioral science at the University of Louisville, analyzed the records of 32 of Williams’ patients, including 10 of those who died in Clay County.
Among Schrodt’s findings:
n There was no documentation Williams discussed the potential risks of using controlled substances, especially in combination with other prescribed or illicit drugs, with his patients.
n There was little notation of patients’ past medical histories. “Most importantly, there was minimal, if any, documentation of concurrent medications or therapies prescribed by other physicians, even when those might have potentially serious interactions with Dr. Williams’ prescriptions.”
n Inadequate time to complete adequate evaluations and management of patients due to extremely high case load.
n Starting patients out with a high dose of Xanax and often increasing it when standard psychiatric care calls for starting with a low dose and adjusting as needed.
In conclusion, Schrodt wrote Williams prescribed medications in such amounts he knew or should have known were excessive and “failed to conform to the standard of acceptable and prevailing medical practice.”
“Based on the sampling of cases I reviewed, it is my opinion that Dr. Williams demonstrated a pattern of acts during the course of the physicians medical practice ... that would be deemed to be gross incompetence, gross ignorance, gross negligence or malpractice,” Schrodt wrote.